County Health Rankings

WASHINGTON - Residents of the nation's least healthy counties die at twice the rate of those living in their states' healthiest counties, despite a major improvement in the rate of premature deaths, according to a national survey of county health statistics released Wednesday.

The full implementation next year of the 2010 health care law could improve health statistics overall, experts say, but real change in health statistics can come only if Americans start eating better and exercising more.

Along with the higher death rates in the least healthy counties, researchers from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation found that:

•More than one in five children live in poverty.
•Violent crime has decreased by 50% during the past 20 years.
•Places with higher death rates have the highest rates of smoking, teen births, physical inactivity and preventable hospital stays.

In general, a state's healthiest county tends to be in a suburban area characterized by higher-income residents, while the least healthy counties have higher concentrations of poor residents, who often have worse eating and exercise habits. In Ohio, for example, the most healthy county is Geauga, east of Cleveland, while the least healthy is Scioto, a rural county along the Ohio River in the southern part of the state.

Texas' most healthy county is Williamson, a fast-growing suburban area outside Austin, while the least healthy is Polk, a rural county northeast of Houston.

In 2014, most Americans will be required by the new law to purchase health insurance or face a fine, and about half of the nation's states will expand Medicaid to people who fall beneath 138% of the federal poverty level.

"I don't think there is any question that the [law] will make a difference, especially for our poorer populations," said Ron Pollack, executive director of Families USA. "The statistics are clear that the uninsured are sicker and dying younger."

Access to quality health care, however, accounts for only 20% of a county's ranking, said Joe Marx, a spokesman for the Robert Wood Johnson Foundation. "Social and economic factors are weighed the most heavily in the rankings," he said.

Health behaviors, such as healthy eating habits and how many people smoke, and a county's physical environment, including parks and water quality, are key components of the ratings.

Though the law's provisions calling for preventive screenings and a doctor's advice for improved eating and exercise habits will help, Pollack said, people will continue to suffer from preventable health problems if they can't find fresh produce or parks where they can exercise.

The law "may improve things, but it almost certainly won't affect the ratings," said Jim Marks, director of the foundation's health group. "Access to health care doesn't affect obesity."

In Pennsylvania, for example, Philadelphia County ranked first in health care but worst in overall health, Marks said.

"In Kansas City, the mayor was concerned about the rankings, so he talked to hospital officials," Marks said. "They said, 'We do well for those who are ill, but we have no say in how they get there.'"

A doctor can tell a poor woman in her mid-50s that she has diabetes, and the doctor can recommend healthy foods and exercise to control that disease.

"But if she goes home and there's no grocery store or it's not safe to get there, she'll get sicker faster - all due to things outside medical care," Marks said. "We can't treat ourselves out of our medical care costs. That's the central message of these county health rankings."

One provision of the law requiring not-for-profit hospitals to conduct community needs assessments to determine how to make their areas healthier may improve overall health, said Bridget Catlin, director of the County Health Rankings & Roadmaps.

"That's an exciting change," Catlin said. "We've seen that the community-wide projects are more effective than advice from a doctor."

As examples, she cited smoking bans or setting aside an area for a park so people have a free place to exercise.

The report shows how each of a state's counties compares with the others, which gives leaders a chance to see how they can create healthier environments.

"The shame can lead to change," Catlin said. "Many counties had no idea they compared."

The County Health Rankings created a Roadmaps to Health contest aimed at creating model programs for counties to use. The winners' plans are available at http://www.countyhealthrankings.org.

In Wyandotte County, Kan., officials lured a grocery store to locate in a low-income neighborhood that had become a "food desert" that had not had such a store in 45 years. Hernando County, Miss., added a community farmers market within walking distance of a low-income neighborhood.